Organization
MICHAEL J. GLIDDON DBA LIVE OAK ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERA ANN WELLNER (CREDENTIALING REP)
(405) 848-7974
Entity
Organization
Contact information
Practice address
1415 NW 33RD ST, LAWTON, OK 73505-3806
(580) 699-3131
(580) 699-3151
Mailing address
3000 UNITED FOUNDERS BLVD, SUITE 237, OKLAHOMA CITY, OK 73112-3958
(405) 848-7974
(405) 848-0033
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
160
OK
Other
Enumeration date
12/06/2010
Last updated
11/13/2013
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